MEDICARE: MS. NOEL BETH OSBORN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636103	OTHER	IL	BCBS
2	7556750	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1497821086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NOEL BETH OSBORN LCPC

Provider Business Mailing Address
First Line	:	2031 W WEBSTER AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-862-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 W WEBSTER AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-862-1487
Fax Number	:	847-491-4939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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